Healthcare Provider Details

I. General information

NPI: 1255839064
Provider Name (Legal Business Name): MATTHEW DOUGLAS HARTMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S HARRISON PLZ
BLUFFTON IN
46714-9400
US

IV. Provider business mailing address

511 MARBOROUGH DR
FORT WAYNE IN
46804-5973
US

V. Phone/Fax

Practice location:
  • Phone: 260-919-4970
  • Fax: 260-919-4000
Mailing address:
  • Phone: 260-223-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26031222A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: